The problem of overweight and obesity is one of the global problems of civilization [1]. Its prevalence on the scale of entire populations stems primarily from unhealthy eating behavior, characterized by increased consumption of high-calorie foods and dishes with excessive sugar content [2, 3]. Insufficient physical activity also aggravates the risk of overweight, as well as type 2 diabetes mellitus, cardiovascular disease, and other conditions caused by obesity [4]. The list of general significant risk factors includes eating disorders (overeating and night eating syndrome), sleep deficiency, and hypodynamia [5]. Thus, those who sleep for less than 8 hours are 3.1 times more likely to be overweight than those who sleep for at least 10 hours [6]. There are also specific risk factors, which basically determine regional features of overweight; being primarily of chemical nature, they slow down metabolic processes [7].

Adipose tissue, as a metabolically active endocrine organ, influences immunity, glucose levels, lipid metabolism, angiogenesis, and metabolic rate. Against the backdrop of obesity and overweight, the body increases the production of pro-inflammatory and atherogenic cytokines, experiences oxidative stress, and faces heightened risks of insulin resistance, dyslipidemia, hypertension, and orthopedic issues [8].

Recent studies indicate that overweight and obesity are risk factors for cardiovascular diseases, with their prevalence continuing to rise [9–13] not only among adults but also among children [14]. The pattern of distribution of adipose tissue in the body is considered one of the key drivers behind cardiovascular pathologies in obese individuals; it particular, the respective conditions are associated with the predominance of visceral fat [15, 16]. There are about 230 complications that obesity contributes to. In addition to the mentioned cardiovascular system disorders, the list includes type 2 diabetes mellitus, diseases such as dyslipidemia, obstructive sleep apnea syndrome, chronic kidney disease, non-alcoholic fatty liver disease, and some cancers [17, 18]. There is evidence that obesity promotes the development of polycystic ovary syndrome [19], and reports describing cases of otorhinolaryngological diseases [20] and inflammatory bowel conditions [21] in obese individuals. Many patients with obesity are more prone to developing respiratory diseases [22]. Studies point to a link between obesity and certain cognitive impairments due to the development of cerebrovascular pathology, which is one of the most common disorder of the nervous system. Thus, published research positions obesity as a global problem, describing it as both a progressing pathology and a risk factor for concomitant diseases that significantly reduce the quality and duration of life. The urgency of this problem substantiated conducting a study within the framework of the Demography national project [23].

This study aimed to assess the mid- and long-term incidence and dynamics of obesity and the diseases associated therewith in various age groups of the population of Voronezh Oblast, and to compare the collected data to the mean figures registered in the Central Federal District (CFD) of the Russian Federation (RF) and the country in general.

METHODS

We analyzed the official statistical data of the Ministry of Health of the Russian Federation (report form #12 "Information on the number of diseases reported in patients living in the service area of the medical organization" and the national statistical books on the general morbidity of children (0–14 years old), adolescents (15–17 years old) and adults (18 years and older)). The analysis covered different age groups; the data described years 2011 through 2020.

We used parametric and nonparametric statistical methods to process the results in MyOffice Standard 3 package (New Cloud Technologies; Russia). The tests employed to check the normality of the distribution and the equality of variances were the Shapiro-Wilk test and Levene's test, respectively. Since the parameters studied exhibited normal distribution, we used parametric methods. The Student's t-test enabled the comparison of numerical data between two independent groups. The differences were considered significant for p < 0.05.

RESULTS

The analysis of obesity prevalence in the Voronezh region during the past decade has revealed an upward trend across all considered age groups, including children (0–14 years old), adolescents (15–17 years old), and adults (18 years and older). From 2016 to 2020, the incidence rates recorded there exhibited pronounced specific features characteristic of the region, and were significantly higher than the average for the RF and the CFD (p < 0.05) (fig. 1).

From 2011 to 2020, the incidence of obesity among children (0–14 years old) in the Voronezh Region was significantly higher than in the RF, with the mean being 35.8% (from 23.7 to 48.7%) (p < 0.05). Compared to the CFD, the figures for the Voronezh Region were higher by 35.0% on average (from 8.1 to 61.5%), which is significant (p < 0.05) (Fig. 1A)/(fig. 1). Compared to the RF, the incidence of obesity was significantly higher (p < 0.05) than the country mean among adolescents (15–17 years old) and adults (18 years old and older), too. Specifically, the figures for adolescents were, on average, 54.4% (from 31.2 to 80.8%) greater than country means, and 51.7% (from 12.3 to 71.3%) greater than the means registered in the CFD (Fig. 1B)/(fig. 1). As for adults, the average values were higher than in the RF by 26.1%, and significant differences were recorded from 2016 on, ranging from 34.3 to 61.9%. Compared to the CFD, with the prevalence dynamics stable, the considered indicator within the studied period was 90.5% higher in the Voronezh Region, and since 2016, the incidence rates there have been more than twice as high as in the CFD (Fig. 1C)/(fig. 1).

Thus, during the period in question, the rates of obesity in all age groups were significantly higher in the Voronezh Region than in the RF (p < 0.05). A similar trend was observed for mental disorders, behavioral disorders, and urolithiasis (tab. 1, tab. 2).

The analysis of morbidity among adults (18 years and older) revealed a significantly higher incidence of digestive system diseases, including gastric and duodenal ulcers, as well as a significant prevalence of diseases with long latency periods, including diseases of the circulatory system, hypertension in particular [9–13]. According to available literature, they may be etiologically linked to obesity (tab. 2).

In the Voronezh Region, diseases of the endocrine system (type 2 diabetes mellitus), digestive disorders, and urolithiasis are in the rise among children and adolescents, whereas in the RF and the CFD, the direction of the trend for these ailments is opposite (fig. 2).

Against the backdrop of a general upward trend in the incidence of diabetes among adolescents, in the Voronezh Region (Fig. 2B)/(fig. 2), the prevalence of this disease was dropping from 2013 to 2016, followed by a significant spike in the period from 2019 to 2020. The situation is similar for the digestive diseases: in 2011, the incidence thereof in the Voronezh District was lower than in the RF in general, but from 2014 on, the trend for such diseases in the said region is upward and stable (Fig. 2C)/(fig. 2). As for urolithiasis, in child population (0–14 years old), a significant increase in the incidence thereof was revealed during the observed period, with the prevalence significantly higher than in the CFD and nationwide (Fig. 2A)/(fig. 2). In adolescents, while the general incidence of urolithiasis was on the rise, in the Voronezh Region, this disease was diagnosed less often that in the RF and the CFD, but from 2017 to 2019, the situation changed to the opposite.

DISCUSSION

Along with the increased incidence of obesity in various age groups of the Voronezh Region population (compared to those registered in the CFD and Russia in general), we have found high prevalence of mental and behavioral disorders that may be associated with obesity, the said association shown in a study [24] that reported the set of obesity-related factors to influence cognitive well-being. The high incidence of urolithiasis requires further study to determine additional factors unrelated to dietary patterns. For the diseases with a long latency period (those of the circulatory and digestive systems), the morbidity rates in the adult population of the Voronezh Region were significantly higher, which may be a consequence of a long-term persistent high level of obesity in children and adolescents, which is also consistent with the available literature [7, 11–14,21].

CONCLUSIONS

Thus, in the Voronezh Region, we found significantly higher obesity indicators across all age groups, with a stable trend over time. Among the specifics elated to this morbidity in the considered territory are the upward trends for the endocrine system (type 2 diabetes mellitus), digestive diseases (gastritis and duodenitis), and urolithiasis in children and adolescents, while the situation registered on the level of the nation in general for these diseases is downward in the respective population cohorts. The results of this study support the need to continue research and investigate the potential risk factors that determine the specifics of morbidity in the given area, including the vitamin and mineral content in the mainstay foods, and factors unrelated to nutrition, such as the chemical composition of drinking water and soil composition.